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Canadian women are “unnecessarily suffering and dying from heart disease” because of gender inequities in the health care system, says a new report by the Heart and Stroke Foundation.

When compared with men, women are not as well researched, diagnosed, treated and supported, according to the document titled “Ms. Understood,” published on Thursday.

“We need to spend more time paying attention to sex and gender differences in cardiovascular disease at all levels,” says Dr. Karin Humphries, scientific director of the BC Centre for Improved Cardiovascular Health in Vancouver.

Two thirds of heart disease clinical research focuses on men.

“For the longest time everything we have done has been predicated on a male model, so if it works in men, it must work in women. And we now understand that that is not necessarily true.”

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The report is based on consultations with health care experts from various fields, data from Canada and abroad, peer-reviewed studies and a survey of 2,000 women. Humphries, a spokesperson for the Heart and Stroke Foundation, says it should serve as “a wake-up call.”

She urges women to talk to their doctors about how to reduce their risk for heart disease, which refers to conditions involving narrowed or blocked vessels that can trigger a heart attack, chest pain or stroke. In Canada, it’s the leading cause of premature death for women.

“There is a lot they can do to minimize their risk,” says Humphries. “Those conversations aren’t happening.”

There’s also a lot that can be done within the health system. For starters, women should be better represented in the research.

In the report, Dr. Ed O’Brien, vice-chair of the Institute of Gender and Health advisory board at the Canadian Institutes of Health Research, writes there’s “still pushback” to that idea.

“Balanced numbers of women in clinical trials can add to complexity and cost, but it is crucial,” writes O’Brien, who is also a professor of cardiac sciences at the University of Calgary. “When you are translating your research into a therapy that will be given to half the population, there is a big problem if it hasn’t been tested on that population or if your results have not been analyzed for that population.”

While the female and male heart look the same, there are differences, states the report. For example, women’s hearts and coronary arteries are smaller, and when compared with men the same age, typically have lower blood pressure and a faster resting heart rate. There are also differences in the way fatty plaque builds up in the vessels. And, women’s hearts are impacted by pregnancy, menopause and hormonal changes throughout their lives.

Traditionally, women were excluded from clinical trials because researchers worried they’d become pregnant. So, tests were done primarily on men, forming the basis of clinical guidelines, diagnostic procedures and therapies still used today for both men and women. As a result, some diagnostic tools may miss heart disease in women.

The discrepancy in how men and women are diagnosed and treated is “a very disturbing picture,” says Humphries.

For example, the treadmill test, or stress test — it reveals blockages in arteries that supply blood to the heart — is very good for men, but less sensitive for women. And the angiogram — a special X-ray test — images major coronary arteries, but not the smaller arteries. The problem here is that men typically have blockage in their larger vessels, whereas women have it in their small vessels. So for those women, the disease could be missed. The report notes women with normal angiograms are four times more likely to be readmitted to hospital for chest pain within six months, compared with men.

“You have two examples of broadly used tests that are optimized for men and really don’t serve women as well as they could,” says Humphries.

Further complicating the picture, women are slower to get to the hospital than men if they’re having a heart attack, says Humphries. And they often present with atypical symptoms. Men typically have crushing chest pain, whereas women may experience pain in their chest, or in their back, jaw, arms or neck.

“Because the presentation is different the health care system will miss it (in women). And if you miss it … you’re going to have a really bad outcome.”

Even when it comes to cardiac rehabilitation programs, which help patients transition from hospital to home, women are half as likely as men to be referred. Humphries says it’s unclear why that’s the case since both benefit equally. Whenwomen are referred, they may not go or complete the program because of work and family responsibilities. She believes the system needs to do a better at convincing women to attend these programs and accommodate them by providing child care or facilitating transportation.

When Nancy Bradley, 58, of Kamloops, B.C. experienced chest pains — early signs of a heart attack — doctors dismissed them as heartburn.

While out with her dog Marley last summer, she experienced difficulty walking, dizziness, sweating, shortness of breath, and “felt like an elephant was sitting on my chest.” She thought she was having a heart attack and drove to emergency. The triage nurse gave her two Aspirins and Bradley waited about an hour to undergo an electrocardiogram (ECG) and blood work. (Ideally patients should get an ECG within 10 minutes of arriving at the hospital.) By that point the pain had subsided and everything appeared normal. The doctor concluded it was heartburn and suggested she take antacids.

“I did explain to him about the family history (of heart disease), but really nothing else was done,” says Bradley, who went home.

Two weeks later when she was walking Marley again she felt the same symptoms.

“I knew if I didn’t get home I was going to die out on that trail,” says Bradley. She made it home and passed out while speaking to the 911 dispatcher. She was rushed to hospital where tests showed 95 per cent blockage on an artery and permanent damage to the heart which doctors suspected was the result of a missed heart attack two weeks earlier.

Looking back, Bradley is disappointed with how her case was handled. By comparison, her brother had a heart attack at age 38, with similar symptoms, and was given immediate care.

“He had way better followup care than I did — I haven’t even seen a cardiologist yet.”

Her appointment is set for late April and she was contacted a few weeks ago by a cardiac rehab program to see if she would attend. She’s back at work now, as an administration clerk, and can’t take time off.

“I’m just winging it right now,” she says. “I absolutely feel like I was let down (by the system) … There were a bunch of things that could have happened that didn’t.”

MS. UNDERSTOOD BY THE NUMBERS

20: The number of minutes before another woman in Canada dies of heart disease.

78: Percentage of women in which early heart attack signs such as shortness of breath, weakness, dizziness are missed.

20: Percentage of women who say their doctors regularly speak to them about heart health.

29: Percentage of women who get an electrocardiogram (ECG) that tests heart electrical patterns within the benchmark 10 minutes, compared with 38 per cent of men.

32: Percentage of women requiring clot-dissolving therapy who got it within the benchmark 30 minutes, compared with 59 per cent of men.

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